Book Review

High-Dose Cancer Therapy: Pharmacology, Hematopoietins, Stem Cells

N Engl J Med 1993; 329:285-286July 22, 1993

Article

High-Dose Cancer Therapy: Pharmacology, Hematopoietins, Stem Cells
Edited by James O. Armitage and Karen H. Antman. 816 pp., illustrated. Baltimore, Williams and Wilkins, 1992. $150. ISBN: 0-683-00254-6

The practice of medical oncology and hematology has been irreversibly altered by the concept of high-dose chemotherapy with marrow rescue -- a euphemism for bone marrow transplantation. Transplantation now has an increasing role in the management of a variety of hematologic cancers and solid tumors. In some diseases, such as breast cancer, both the medical-practice and medical-insurance aspects of bone marrow transplantation have become emotionally charged. Therefore, it is critical that reference material be available for the oncologist in training and the practicing oncologist not directly involved in this high-technology area. To my knowledge, there is no previous comprehensive textbook on high-dose chemotherapy. Standard hematology and oncology textbooks review this entire field in one chapter. I was therefore very excited to receive this book to review. Although it has some problems, I believe it makes a solid start in filling a void in reference material on this quickly evolving field. Some experts may scoff at any book that tries to tackle a field that is in a state of flux because it becomes outdated even before publication. I disagree. These books are important for perspective and background, and they help build a solid foundation for the newest data.

Two leaders in the field of high-dose therapy have edited High-Dose Cancer Therapy. The book has four sections. The first deals with the rationale for high-dose chemotherapy and radiotherapy. The second concerns many aspects of hematopoietic rescue, including allogeneic marrow, autologous marrow, and peripheral-blood stem cells; growth factors; and the concept of purging. The third section focuses on the ancillary supports needed for transplantation, and the final section is a collection of chapters on the clinical approach to a variety of hematopoietic and solid tumors with high-dose therapy. The book is weighted more heavily toward autologous transplantation and less toward allogeneic transplantation, which appropriately reflects the tremendous surge in the number of autologous transplantations being performed. The chapters on the economic impact of transplantation and nursing care of the transplant recipient are welcome additions. Highly controversial areas such as bone marrow purging are accurately and fairly presented; the authors rightly conclude that randomized trials will be needed to settle the controversy over purging.

In general, the chapters are clearly written. They are as up to date as possible, with many references from late 1991. Unfortunately, many of the chapters are written as if meant to be published separately rather than as part of a comprehensive textbook; as a result, there are redundancies and occasional contradictions. The lack of effective cross-referencing between chapters is especially evident throughout the section on colony-stimulating factors. Several clinical chapters (e.g., “Dose-Intensive Therapy in Breast Cancer”) rely too heavily on clinical trials performed at the authors' own institutions, which detracts from the otherwise well presented broad perspective. The figures are adequate but lack a standardized format. One striking omission is the absence of a chapter on graft-versus-host disease, although that complication is mentioned in many chapters. A single chapter on this topic would help the reader put this important complication into perspective. Errors should be corrected in later editions.

The strong point of the book is that it covers a great deal of territory in a rapidly evolving field. It is very useful to move quickly from a chapter on peripheral-blood stem cells to an excellent chapter on Hickman line management. This book is not a hands-on guide with firm recommendations, but it will serve as a solid reference base and will be a useful addition to the library of the hematology-oncology fellow in training and the hematologist or oncologist in clinical practice who is not involved in the administration of high-dose chemotherapy. Physicians performing bone marrow transplantation will also find this book an excellent reference guide.

David P. Schenkein, M.D.
New England Medical Center, Boston, MA 02111